Coaxial catheter system

ABSTRACT

A robotic medical system and method of performing a medical procedure are provided. The robotic medical system comprises a user interface configured for receiving commands, an electromechanical driver configured for being coupled to outer and inner catheters having proximal and distal balloons, a balloon controller configured for being coupled to the proximal and distal balloons, and an electric controller configured for directing the electromechanical driver to linearly translate the outer and inner catheters relative to each other and for directing the balloon controller to inflate and deflate the proximal and distal balloons in response to the command(s). The method may comprise inflating and deflating the proximal and distal balloons, and linearly translating the inner and outer catheters relative to each other in a specified sequence to move the inner and outer catheters along the anatomical vessel.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/270,740, filed Oct. 11, 2002 now abandoned, which claims the benefitof U.S. Application Ser. No. 60/332,287, filed Nov. 21, 2001, and is acontinuation-in-part of U.S. application Ser. No. 10/216,069, filed Aug.8, 2002 now abandoned, which claims the benefit of U.S. Application Ser.No. 60/313,495, filed Aug. 21, 2001, and is a continuation-in-part ofU.S. application Ser. Nos. 10/023,024 (now abandoned), 10/011,371 (nowU.S. Pat. No. 7,090,683), 10/011,449 (now abandoned), 10/010,150 (nowU.S. Pat. No. 7,214,230), 10/022,038 (now abandoned), and 10/012,586 nowU.S. Pat. No. 7,371,210, all filed Nov. 16, 2001, and all of which claimthe benefit of U.S. Application Ser. Nos. 60/269,200, filed Feb. 15,2001, 60/276,217, filed Mar. 15, 2001, 60/276,086, filed Mar. 15, 2001,60/276,152, filed Mar. 15, 2001, and 60/293,346, filed May 24, 2001.

This application is also related to U.S. application Ser. Nos.11/762,749, 11/762,751, and 11/762,748, all of which are filed on thesame date herewith. The entire disclosures of the above applications areexpressly incorporated herein by reference

BACKGROUND OF THE INVENTION

Catheters are used extensively in the medical field in various types ofmedical procedures, as well as other invasive procedures. In general,minimally invasive medical procedures involve operating through anatural body opening or orifice of a body lumen, or through smallincisions, typically 5 mm to 10 mm in length, through which instrumentsare inserted. In general, minimally invasive surgery is less traumaticthan conventional surgery, due, in part, because no incision is requiredin certain minimally invasive procedures, or the significant reductionin the incision size in other procedures. Furthermore, hospitalizationis reduced and recovery periods are shortened as compared withconventional surgical techniques.

Catheters maybe provided in a variety of different shapes and sizesdepending upon the particular application. It is typical for a clinicianto manipulate the proximal end of the catheter to guide the distal endof the catheter inside the body, for example, through a vein or artery.Because of the small size of the incision or opening and the remotelocation of the distal end of the catheter, much of the procedure is notdirectly visible to the clinician. Although clinicians can have visualfeedback from the procedure site through the use of a video camera orendoscope inserted into the patient, or through radiological imaging orultrasonic imaging, the ability to control even relatively simpleinstruments remains difficult.

In view of the above, some have proposed using robotic tele-surgery toperform minimally invasive procedures. Typically, these robotic systemsuse arms that reach over the surgical table and manipulate the surgicalinstruments inserted into the patient, while the surgeon sits at amaster station located a distance from the table and issues commands tothe arms.

SUMMARY OF THE INVENTION

In accordance with a first aspect of the present invention, a roboticmedical system for use with a catheter having a balloon is provided. Therobotic medical system comprises a user interface (e.g., one thatincludes at least one of a dial, joystick, wheel, and mouse) configuredfor receiving at least one command, an electromechanical driverconfigured for being coupled to the catheter, and a balloon controllerconfigured for being coupled to the balloon of the catheter. In oneembodiment, the electromechanical driver includes a catheter controlconfigured for mechanically interfacing with the catheter, and a motorarray configured for manipulating the catheter control.

The robotic medical system further comprises an electric controllerconfigured for directing the electromechanical driver to mechanicallymove the catheter within at least one degree-of-freedom (e.g., a lineartranslation or axial rotation of the catheter, or an actuation of anarticulating tool of the catheter) and for directing the ballooncontroller to inflate and deflate the balloon in response to thecommand(s). In one embodiment, the electromechanical driver isconfigured for being coupled to an elongated medical implement in acoaxial arrangement with the catheter, in which case, the electricalcontroller is configured for directing the electromechanical driver tolinearly translate the catheter and the medical implement relative toeach other in response to the command(s). In another embodiment, theuser interface is located remotely from the electromechanical driver andthe balloon controller, and electrical controller is coupled to theelectromechanical driver and the balloon controller via externalcabling.

In accordance with a second aspect of the present inventions, a roboticmedical system for use with a coaxial catheter arrangement of an outercatheter having a proximal balloon and an inner catheter having a distalballoon is provided. The robotic medical system comprises a userinterface (e.g., one that includes at least one of a dial, joystick,wheel, and mouse) configured for receiving commands, anelectromechanical driver configured for being coupled to the outer andinner catheters, and a balloon controller configured for being coupledto the proximal and distal balloons. In one embodiment, theelectromechanical driver includes outer and inner catheter controlsconfigured for respectively mechanically interfacing with the outer andinner catheters, and a motor array configured for manipulating the outerand inner catheter controls.

The robotic medical system further comprises an electric controllerconfigured for directing the electromechanical driver to linearlytranslate the outer and inner catheters relative to each other and fordirecting the balloon controller to inflate and deflate the proximal anddistal balloons in response to the commands. In one embodiment, theelectrical controller is configured for directing the electromechanicaldriver to linearly translate the catheter and the medical implementrelative to each other and/or actuate an articulating tool of the innercatheter in response to the commands. In another embodiment, theelectric controller is configured for automatically directing theelectromechanical driver in accordance with a predetermined sequence inresponse to the commands. For example, the predetermined sequence may beinflating the proximal balloon, linearly translating the inner catheterrelative to the outer catheter in the distal direction, inflating thedistal balloon, deflating the proximal balloon, linearly translating theouter catheter relative to the inner catheter in the distal direction,and deflating the distal balloon. In still another embodiment, the userinterface is located remotely from the electromechanical driver and theballoon controller, and electrical controller is coupled to theelectromechanical driver and the balloon controller via externalcabling.

In accordance with a third aspect of the present invention, a method ofperforming a medical procedure is provided. The method comprisesintroducing the coaxial catheter arrangement, which includes an outercatheter having a proximal balloon, and an inner catheter having adistal balloon, within an anatomical vessel (e.g., a blood vessel) of apatient. The method further comprises inflating the proximal balloon toanchor the outer catheter within the anatomical vessel, linearlytranslating the inner catheter relative to the outer catheter within theanatomical vessel in the distal direction, inflating the distal balloonto anchor the inner catheter within the anatomical vessel, deflating theproximal balloon to release the outer catheter from the anatomicalvessel, linearly translating the outer catheter relative to the innercatheter within the anatomical vessel in the distal direction, anddeflating the distal balloon to release the inner catheter from theanatomical vessel.

An articulating tool on the inner catheter may optionally be actuatedwithin the anatomical vessel. In one method, the foregoing steps arerepeated to cause incremental movement of the coaxial catheterarrangement within the anatomical vessel. In another method, theforegoing steps are automatically performed in accordance with apredetermined sequence. In still another method, an electric controlleris used to direct an electromechanical driver to linearly translate theouter and inner catheters relative to each other and for inflating anddeflating the proximal and distal balloons. In this case, the method mayfurther comprise conveying at least one command to the electriccontroller via a user interface.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the invention.

FIG. 1 is a schematic perspective view of a coaxial catheter inaccordance with the present invention;

FIG. 2A is a side view of the coaxial catheter system of FIG. 1;

FIG. 2B is a cross-sectional view of the catheter system illustrated inFIG. 2A;

FIG. 3 is a schematic and block diagram of the coaxial catheter systemin accordance with the present invention;

FIG. 4 is a block diagram of another embodiment of the present inventionemploying controllable balloons for controlled movement of the coaxialcatheter system;

FIG. 5 is a timing diagram associated with the block diagram of FIG. 4;

FIG. 6 is a schematic diagram illustrating the coaxial catheterarrangement and associated proximal and distal balloons, associated withthe block diagram of FIG. 4;

FIG. 7 is a schematic diagram illustrating another aspect of the presentinvention employing a detector;

FIG. 8 is a schematic and block diagram of still another embodiment ofthe present invention;

FIG. 9 illustrates another principle of the present invention in acoaxial catheter system illustrated being used in a vein or artery;

FIG. 9A illustrates a multi-lobed balloon of the system of FIG. 9;

FIG. 10 illustrates another embodiment of the invention for distal driveof one of the catheters;

FIG. 11A a block and schematic view a catheter drive system with a fluiddelivery system in accordance with the invention;

FIG. 11B is a close-up view of a manifold of the fluid delivery systemof FIG. 11A;

FIG. 12 illustrates a catheter coupled to a catheter drive mechanism inaccordance with the invention;

FIG. 12A is a cross-sectional view of the drive mechanism of FIG. 12;

FIG. 13 illustrates the catheter of FIG. 12 and a guide wire coupled torespective drive mechanisms in accordance with the invention;

FIG. 14 illustrates the linear movement of the drive mechanisms of FIG.13;

FIGS. 15A-15C illustrate various devices used to move the drivemechanisms of FIG. 13 in a linear manner;

FIG. 16 is a perspective view of the catheter and guide wire of FIG. 13shown coupled to respective drive mechanisms of a base unit;

FIG. 16A is a top view of one of the drive mechanisms shown in FIG. 16;

FIG. 16B is a view of the drive mechanism of FIG. 16A taken along theline 16B-16B;

FIGS. 17A-17C illustrate a connector used to couple the catheter andguide wire to their respective drive mechanisms;

FIGS. 18 and 18A illustrate an alternative embodiment of the connector;and

FIGS. 19, 19A and 19B illustrate yet another embodiment of theconnector.

FIGS. 20A and 20B illustrate yet another embodiment of the connector.

DETAILED DESCRIPTION OF THE INVENTION

A description of preferred embodiments of the invention follows.Referring to FIG. 1 there is shown a catheter system 5 including threeseparate catheter shafts 10, 20, and 30, with an end effector 12supported at the distal end of the catheter shaft 10. The end effector12 may be, for example, an articulated tool such a grasper with a pairof jaws 12 a and 12 b that pivot about a joint 15 to grasp an itembetween the two jaw members. Other articulated tools that may be used asthe end effector 12 include scissors, needle holders, micro dissectors,staple appliers, tackers, suction irrigation tools, and clip appliers.The end effector 12 can also be a non-articulated tool, such as acutting blade, probe, irrigator, catheter or suction orifice, anddilation balloon. Further details of catheter systems, particularlythose relating to mechanisms for multiple degrees-of-freedom of motionof catheter shafts can be found in U.S. application Ser. Nos.10/023,024, 10/011,449, 10/022,038, 10/012,586, by Brock, Lee, Weitznerand Rogers, 10/011,371, by Brock, Lee, Weitzner, Rogers, and Ailenger,and 10/010,150, by Brock, Lee, Weitzner, Rogers, and Cunningham, all ofwhich were filed Nov. 16, 2001 and are incorporated herein by referencein their entirety.

Each of the catheter shafts 10, 20, and 30 has a different diameter thatis able to move with multiple degrees-of-freedom. The catheter shaftsshown in FIG. 1 are arranged in a coaxial manner with the small diametercatheter 10 positioned inside the medium diameter catheter 20 which inturn is positioned inside the large catheter 30. The arrangement in FIG.1 is a coaxial arrangement with the small diameter catheter 10 adaptedfor sliding inside of the medium diameter catheter 20.

As illustrated in FIG. 1, as well as FIG. 2A, the catheter 30 is able tomove with a linear translation in the direction 31, while the mediumdiameter catheter 20 is able to slide inside the catheter 30 with alinear translation motion in the direction 21, and the small catheter 10is able to slide inside the medium catheter with a linear translationmotion in the direction 11.

In addition to the translation motions, each of the catheter shafts 10,20, and 30 is able to rotate and bend. Hence, the shafts 10, 20, and 30have three degrees-of-freedom of movement. The rotational motion of thecatheters 10, 20, and 30 is indicated by the double arrows S_(3R),S_(2R) and S_(1R), respectively, and the orthogonal bending motions ofthe catheters 10, 20, and 30 are indicated by the double arrows S_(3B1)and S_(3B2), S_(2B1) and S_(2B2) and S_(1B1) and S_(1B2)

Referring also to FIG. 2B, there is shown the coaxial arrangement of thecatheters 10, 20, and 30, as well as the rotational motions of thecatheters identified by the double arrows 13, 23, and 33, respectively.Indicated in FIG. 2A are the operative segments 01, 02, and 03 of therespective catheters 10, 20, and 30 where the bending may occur in eachof the catheters. As shown, this bending generally occurs near thedistal end of the respective catheters. However, the operative segmentsmay also be located at different places along each of the catheters ormay not be required at all.

Turning now to FIG. 3, the multiple coaxial catheters 10, 20, and 30 areshown coupled to a drive system 35. Also shown in FIG. 3 are theoperative sections 01,02, and 03 of the catheters 10, 20, and 30,respectively, as well as the linear translational degree-of-freedom 11,21, and 31. At some position along the catheters, there is a patientinterface, not specifically illustrated in FIG. 3 but considered to bethe location where the catheter enters the anatomic body. The entry ofthe catheter may, for example, be percutaneously, via an incision, oreven through a natural body orifice. Procedures to be described beloware particularly adapted for transitioning a multi-shaft catheterconstriction through an anatomic body vessel such as through theintestines. Of course, the concepts of the illustrated embodiments maybe used in association with the control and transition of the cathetersthrough other body vessels or body cavities as well.

Each catheter 10, 20, and 30 is arranged and supported in a manner toenable multiple degrees-of-freedom of the catheter including movement ofthe catheter to an anatomic body target site, as well as rotation of thecatheter. In particular, there are respective support blocks 40, 50, and60 associated with the catheters 10, 20, and 30. In the embodimentillustrated in FIG. 3, these support blocks 40, 50, and 60 are coupledto the respective proximal ends of the catheters identified as 10A, 20A,and 30A. Each of the support blocks controls linear translationalmovements of the catheters with the use of wheels 42, 52, and 62. Insupport block 40, there is also illustrated control of the rotationalmotion 46 of the catheter 10. Similarly, support blocks 50 and 60provide rotational control 56 and 66 to the respective catheters 50 and60.

The drive system 35 also includes an electromechanical drive member 70coupled to the support blocks 40, 50, and 60 with mechanical cablings80, 81, and 82, respectively. The drive member 70 is a under thedirection of a controller 72 that is also coupled to an input device 76which interfaces the drive system 35, and hence the catheter system 5,with a user who is typically a surgeon.

In the illustrated embodiment, the electromechanical drive member 70 isa motor array with a plurality of drive motors. The mechanical cablings80, 81, and 82 provide control of the respective blocks and controls thelinear and rotational movement of the respective catheters. Thus, in themotor array 70, there can be at least one motor for controlling lineartranslation, and a separate motor for controlling rotational translationrelative to each of the support blocks.

Thus, when the system 35 is in use, the surgeon provides instructions tothe controller 72 through the input device 72. In turn, the controller72 directs the operation of the motor array 70 and hence the supportblocks 40, 50, and 60 which drive the respective catheters with multipledegrees-of-freedom of movement.

The motor array 70 also includes separate motors for driving the bendingmovements S_(3B1) and S_(3B2), S_(2B1) and S_(2B2) and S_(1B1) andS_(1B2) of the catheters as previously indicated in FIG. 1. In FIG. 3,in addition to the operative segments 01, 02, and 03 where the bendingof the individual catheter occurs, there are also shown in cut-outcross-section in each of the catheters respective cablings C1, C2, andC3. These cablings extend along the length of the respective cathetersand can be used for controlling the bending of the operative segments.Also, cabling that extends through catheters 10, 20, and 30 can be usedto operate the end effector 12 as well. The cabling C1, C2, and C3 canextend through the catheters and through the corresponding supportblocks, coupling through the various mechanical cablings 80, 81, and 82.Accordingly, there may be control motors in the motor array 70 thatcontrol the bending movements of the catheters, as well as operation ofthe end effector 12. Further details of mechanical cabling used for theoperation of catheters including bending and flexing thereof can befound in the U.S. application Ser. Nos. 10/023,024. 10/011,371,10/011,449, 10/010,150, 10/022,038, and 10/012,586 mentioned earlier.

In some embodiments, the controller 72 is a microprocessor that receivesinput commands from the input device 76. The input device 76 can be oneof various types of controls such as a dial, joystick, wheel, or mouse.A touch-screen can also be employed as the input device 76 to allow thesurgeon to input information about the desired location of a particularportion of the catheter by touching the screen. In this regard,reference may also be made to the U.S. Application entitled “CatheterTracking System,” by Weitzner and Lee, U.S. application Ser. No.10/216,669, filed herewith, the entire contents of which areincorporated herein by reference, which describes a catheter trackingsystem that enables an operator at the input device to select aparticular anatomic body site and direct the catheter automatically tothat site.

Referring to FIGS. 4, 5 and 6, there is shown another implementation ofthe catheter control. Here, the system employs multiple catheters withmultiple balloons in combination with a control mechanism by which theballoons are inflated and deflated to move the catheters in incrementsthrough a body vessel. In FIG. 6, a set of catheters 110, 120, and 130are located within a body vessel 100. Associated with catheter 120 is adistal balloon D. and similarly, associated with the distal end ofcatheter 130 is a proximal balloon P. In FIG. 6 there are also shownports D1 and P1 through which air or other fluid is introduced into eachof the balloons to inflate the balloons or removed to deflate theballoons. In FIG. 6 the proximal balloon P is shown inflated and thedistal balloon D is shown deflated. Note that although only two balloonsare shown, one or more additional balloons can be associated with athird or even a fourth catheter.

In the block diagram of FIG. 4 there is identified an inner catheter 86and an outer catheter 87, which may correspond respectively to catheters120 and 130 in FIG. 6. Also illustrated in FIG. 4 is an inner cathetercontrol 84 and an outer catheter control 85. These controls may besimilar to the controls illustrated in FIG. 3 for at least controllingthe advancement in a linear manner of the corresponding catheter. Thus,the catheter control 84 can be considered as controlling the linearmovement of the inner catheter 86 while the catheter control 85 can beconsidered as controlling the linear translation of the outer catheter87.

The outputs of a motor array 90 are coupled to the inner cathetercontrol 84 and the outer catheter control 85, while a controller 92 iscoupled to and controls the motor any 90. An input device 96 connectedto the controller 92 provides an interface for a user such as surgeon tooperate the inner and outer catheters 86 and 87.

Also illustrated in FIG. 4 is a balloon controller 94 associated withthe controller 92 and that has two separate outputs coupled to theproximal, P, and distal, D, balloons. Under the direction of thecontroller 92 the balloon controller controls the inflation anddeflation of the proximal balloon P and the distal balloon D. Detailsabout the timing of the inflation and deflation sequence are illustratedin FIG. 5.

The proximal, P, and distal, D, balloons are inflated and deflated in asequence in association with advancement of the different cathetersegments 86 and 87. This is carried out so that the catheters canprogress in increments under automatic control. Hence, the surgeon orother operator need not direct the catheter continuously by hand, butinstead the controller 92 initiates a sequence by which the cathetercreeps or advances in increments through a vessel 100 (FIG. 6).

An example of the timing sequence for the advancement of the inner andother catheters 86 and 87 of FIG. 4 or 120 or 130 of FIG. 6 isillustrated in FIG. 5. Once the advancement sequence is initiated, forexample, through the input device 96, no further control via the inputdevice is necessary. Instead the controller 92 simply repeats apredetermined sequence to cause incremental movement of the cathetersystem through the body.

FIG. 5 depicts certain timing actions relating primarily to theinflation and deflation of the balloons, P and D, as well as the forwardadvancement of the catheters 86 and 87, or 120 and 130.

In step (a), there is an inflation of the proximal balloon P. Thiscauses the catheter 130 to lock against the side wall of the vessel 100to create an anchor point for the distal end of the catheter 130.

Next, in step (b) the inner catheter 120 is advanced by a certain amountin the vessel 100. Note that, as illustrated in FIG. 6, the distalballoon D is deflated, and thus is not locked in position but is readilymoveable in a forward direction with the catheters 110 and 120.

In step (c), the process inflates the distal balloon D, which locks thedistal end of catheter 120 to the inner wall of the vessel 100.Subsequently, the proximal balloon P is deflated so that it is no longerlocked against the inner wall of the vessel 100. The outer catheter 130is then free to move.

In step (e) the outer catheter 130 in FIG. 6 is moved forward carryingthe proximal balloon P. which has previously been deflated allowing itto move readily through the vessel 100.

After the catheter 130 and its associated proximal balloon P has moved acertain distance, then, as illustrated in step (f) the process againinflates the proximal balloon P, and in step (g) deflates the distalballoon D. Once this occurs, the catheter system is then in the positionillustrated in FIG. 6, having advanced by an incremental amount relatedto the length of movement of the inner and outer catheters 120 and 130.

Note that the particular control illustrated in FIGS. 4-6 does notnecessarily require the use of an input device. Alternatively, if aninput device is used, it can be of the type that simply initiates asequence that is stored in the algorithm of controller 92. Hence again,in this way, once the sequence is initiated, then subsequent moves arecontrolled by the controller 92 and not by any specific manipulations atthe input device 96.

Moreover, there may also be provided a force feedback, usuallyassociated with a distal catheter 110. If the distal end of thiscatheter, or an end effector supported at the distal end, detects anobstruction or some blockage that provides a force feedback signal tothe controller, then the controller may interrupt the sequence of stepsdepicted in the timing diagram of FIG. 5. This enables the surgeon toobserve the position of the catheters, for example, through the use ofknown display techniques including Fluoroscopy, Ultrasound, MRI, CT, orPET.

Referring now to FIG. 7, there is shown another embodiment of a cathetersystem having separate catheters 210, 220 and 230, and a detector 240.For illustrative purposes, the catheter 220 may be considered a proximalcatheter, while the catheter 210 may be considered a distal catheter. Adrive system such as that shown in FIG. 3 is used for the lineartranslation of the catheters. A particular feature of the cathetersystem shown in FIG. 7 is a feedback signal provided to the detector 240to indicate movement of the catheters, as well as relative movementbetween catheters. To accomplish this, each of the catheters 210, 220,and 230 is provided with indicia 211, 221, and 231, respectively, thatmay be of the optical type. The detector 240 may be or include a counterthat counts passing indicia.

As an example, if the catheter 220 is stationary and the catheter 210 isbeing moved forward linearly, then the detector 240 such as an opticalsystem can simply read the indicia 211 as the catheter 210 movescoaxially out of the catheter 220. Each of the indicia is separated by apredetermined length and the optical system simply reads each indicia asit moves relative to an adjacent fixed catheter to determine the overalldistance of movement of the catheter system.

The detection system 240 illustrated in FIG. 7 may be used with theincremental advancement system depicted in FIGS. 4-6. In connection withthe balloons illustrated in FIGS. 4 and 6, mention has been made of theincremental forward movement of the inner and outer catheters 86 and 87,or 120 and 130. The optical detection scheme illustrated in FIG. 7 canbe used to measure the distance of movement of either or both of thecatheters.

A further embodiment is illustrated in the schematic and block diagramof FIG. 8. Unlike the drive arrangement shown in FIG. 3 where coaxialcatheters are driven from their proximal ends, the catheters 210, 220,and 230 shown in FIG. 8 are driven from their distal ends. The cathetersystem also implements the indicia and detector 240 described withreference to FIG. 7.

Here, the catheter 220 is considered the proximal catheter and thecatheter 210 is considered the distal catheter. The operation of thecatheters 210, 220, and 230 are controlled from the drive member 160.The drive member 160 may be placed at the master station of FIG. 3, orcontrolled from a remote location such as at the master station, usuallywith surgeon input control.

Each catheter is driven relative to an adjacent coaxial catheter member,such as catheter 220 relative to catheter 230, with drive mechanisms 150and 140 mounted to frame pieces 225 and 235 extending from more proximalcatheters.

In FIG. 8 there are illustrated two drive blocks 140 and 150 whichcontrol the respective catheters 210 and 220. Note that the cathetersystem of FIG. 8 may also include the proximal drive arrangement of FIG.3 for one or more of the catheters. If both proximal and distal drive isused for any one particular catheter, then the proximal drive may beconsidered as a “coarse” drive while the more distal drive may beconsidered as a “fine” drive.

The drive block 140 includes wheels 142 for controlling lineartranslation of the catheter 210, as illustrated by arrow 144. In thedrive block 140 there is also illustrated rotational translation of thecatheter 210, as illustrated by the arrow 146. In a similar manner, thelinear translation relating to drive block 150 is represented by wheels152 indicated by the arrow 154. Also, with regard to drive block 150,and catheter 220, the arrow 156 illustrates rotational movement of thecatheter 220 produced by the drive block 150.

FIG. 8 also illustrates the feedback signal to the detector 240 to senseincremental of movement of the respective catheters. For this purpose,on each of the catheters there is provided indicia that may be of theoptical type described earlier. In FIG. 8 these are indicated as indicia211 on catheter 210, indicia 221 on catheter 220, and indicia 231 oncatheter 230. The detector 240 may include a counter that counts passingindicia to indicate the liner distance of relative movement betweencatheters.

Although the drive blocks 140 and 150 are shown in a schematic fashionabout each of their respective catheters, it is understood that thedrive mechanisms can also be employed within the catheter construction,such as shown in FIG. 10, or other drives may be employed betweenadjacent catheters. Also, the block 160 illustrated in FIG. 8 as a driveblock may in practice be cabling that connects back through thecatheters to the motor array, such as the motor array 70 depicted inFIG. 3. In this way, at an input device, such as the input device 76 inFIG. 3, the surgeon can control the movement of the catheters in both aproximal manner and in a distal manner, or either manner.

The feedback at detector 240 may be incorporated with the drive 160 sothat the drive provides for “fine” movement of catheters in anincremental manner. The movement is fed back by way of detector 240 toprovide for fine adjustment of the catheters, particularly the smallerdiameter distal catheter 210.

Mention has been made that control of the movement of the catheters canbe provided at both the proximal and distal ends of the coaxial cathetersystem. For certain procedures, it may be advantageous to control theproximal end of the catheters, as well as directly control the movementat the distal end of the catheters. For example, FIG. 9 depicts acoaxial catheter system extending through the aorta 300 of the heart 304and used in a vascular artery 302 that may be considered as including amain artery and several branches of the artery that are to be negotiatedby the catheter system.

In the particular embodiment illustrated in FIG. 9 the coaxial cathetersystem includes a large outer catheter 330, a middle catheter 320, and asmall distal or inner catheter 310. The distal end of the catheter 310supports or carries an end effector 312 which may be in the form of ajaw member. For the particular system depicted in FIG. 9, the outercatheter 330 and the middle catheter 320 are driven from theirrespective proximal ends in a manner as illustrated in FIG. 3 with theuse of the input device 76, controller 72, and motor array 70.

To position each of the separate catheters, there is illustrated in FIG.9 a fixing or securing means such as balloon 332 located at the distalend of large outer catheter 330 and balloon 322 located at the distalend of the middle catheter 320. Each of these balloons may be inflatedto hold its corresponding catheter in a relatively fixed position in thebody vessel. Alternatively, rather than the use of balloons, othersecuring devices may be employed such as sonic type of expandablemechanical member. Regardless of the type of securing member employed,it is capable of being operated by the surgeon from a remote location atthe master station, and at the appropriate time selected by the surgeon.The balloons 322 and 332 can be a single lobed balloon that totallyobstructs the vessel when inflated. Alternatively, the balloons may havea multi-lobed configuration as illustrated in FIG. 9A. The balloon 322or 332 shown in FIG. 9A has three lobes 305 that when inflated in avessel 306 allows fluid to flow in the space 307 between the lobes. Theballoon 322 or 332 can have fewer or more than three lobes in otherarrangements. In certain implementations, the individual lobes can beinflated independently of each other.

Initially, both the middle catheter 320 and the small inner catheter 310may be in a withdrawn position, coaxially positioned within the outercatheter 330. When the outer catheter 330 is controlled by the surgeonto be positioned in the manner illustrated in FIG. 9, the surgeon canthen instruct the balloon 332 to inflate to secure the outer catheter330 in the position illustrated in FIG. 9. The balloon 332 expandsagainst the walls of the vessel and essentially locks the outer catheterin position, particularly at its distal end.

Next, under the control of the surgeon through the use of an inputdevice, the middle catheter 320 is moved forward linearly through thevessel of the anatomy. The control of the forward movement of thecatheter 320 relative to the catheter 330 may be carried out in a mannerillustrated in FIG. 3 from the proximal end of the catheter 320.

Previously, mention was made that the balloon 332 is inflated to securethe outer catheter 330. After the middle catheter 320 is moved forwardsome distance, then the balloon 322 may also be inflated. This procedureis under the surgeon's control at the master station through the inputdevice to now secure the distal end of the middle catheter 320 at anappropriate position within a body vessel.

For “fine” control of the small inner catheter 310, it is intended, inthe embodiment of FIG. 9, that the control of the inner catheter 310 isimplemented in the manner illustrated in FIG. 8 in which the support anddrive block 140 can provide direct drive of the inner catheter's 310forward linear movement out of the middle catheter 320. Although thedrive is located at the distal end of the catheter, the drive isremotely controlled by the surgeon at the master station. Again, thiscontrol can be by way of an input device such as an input interface or ajoystick moved in a direction to cause a consequent movement of thevarious catheters depicted in FIG. 9.

Because of the significant length of the catheters that may be employedin a surgical procedure, it may be desirable to provide direct drive ofthe inner catheter 310 at its distal end, rather than drive it at itsproximal end. For example, this may be particularly desirable when thelength of the entire catheter system is so long that it may have sometendency to deflect or bend even when secured by, for example, theballoons 322 and 332.

After the balloons 322 and 332 are inflated, the surgeon at the masterstation can continue to control the forward movement of the distal endof inner catheter 310. As indicated previously, the drive for the innercatheter 310 is typically of the type illustrated in FIG. 8, or in FIG.10 discussed below.

In FIG. 10, the small diameter inner catheter 310 is driven relative tothe middle diameter catheter 320. The linear movement of the catheter310 is illustrated by the arrow 352 when driven by the wheels 350. Therotation of the catheter 310 relative to the catheter 320 is driven theblock 354, as indicated by the rotational arrow 356.

FIG. 10 also illustrates a detector or reader 360. This again may be anoptical device that detects the passage of the indicia 311 on the innercatheter 310. Appropriate electrical signal lines coupled from thedetector 360 back to the master station transmit information related tothe movement of the inner catheter 310 relative to the middle catheter320.

The detector 360 may also be used for detecting rotation of the catheter310 relative to the catheter 320. For this purpose, in addition to thelinear set of indicia 311 on the catheter 310, the catheter 310 is alsoprovided with additional indicia 315 that extend about the circumferenceof the catheter. The reader 360 is able to read not only linear passageof indicia 311, but also read rotation of the indicia 315 from onelinear set of indicia 311 to the next.

Although a single detector 360 is shown in FIG. 10, other detectors mayalso be employed. For example, one detector could be used for detectinglinear translation of the catheter 310, and a second detector could beused for detecting rotation of the catheter 310 with the use of indicia315.

The catheter drive system described above can be implemented in otherconfigurations as well. For example, there is shown in FIG. 11A acatheter drive system associated with a fluid or drug delivery system.Note in FIG. 11A, emphasis is placed on the proximal end of a catheter1070 and guide wire 1072. The more distal portion of the catheter isidentified by the dotted lines. Details of the distal portions of thecatheter 1070 and guide wire 1072 can be found in the U.S. Applicationentitled “Catheter Drive System,” by Weitzner, U.S. application Ser. No.10/216,067, filed herewith, the entire contents of which areincorporated herein by reference.

At some position along the catheter 1070, there is a patient interfaceillustrated at 1074 where the catheter may be considered as enteringinto the patient's body. The entry of the catheter may, for example, bepercutaneously, via an incision, or even through a natural body orifice.

A support block 1076 supports the catheter 1070 in a manner to enable atleast two degrees-of-freedom of the catheter including axial movement ofthe catheter to an anatomic body target sit; as well as rotation of thecatheter. The support block 1076 controls both the linear translation ofthe catheter 1070 by the wheels 1078, as indicated by the arrow 1079,and the rotational translation of the catheter, as illustrated by thearrow 1080. Again, further details of such a catheter support systemillustrating multiple degrees-of-freedom can be found in the U.S. patentapplication Ser. Nos. 10/023,024, 10/011,371, 10/011,449, 10/010,150,10/022,038, and 10/012,586 mentioned earlier.

In FIG. 11A, there is also a block 1082 which controls the movement ofthe guide wire 1072. In particular, the wheels 1084 move the guide wire1072 in a linear manner in the direction 1085. The block 1082 is alsoable to rotate the guide wire 1072 in the direction 1086. Note that theblocks 1076 and 1082 can be supported on a common support structure1120. Although the support 1120 provides a physical connection betweenthe blocks 1076 arid 1082, the blocks are operated independently so thatthe guide wire 1072 and the catheter 1070 can be driven independently ofeach other.

The drive or support blocks 1076 and 1082 are coupled to anelectromechanical drive member or motor array 1090 that controls themovements of both the catheter 1070 and the guide wire 1072 with atleast two degrees-of-freedom. In particular, mechanical cablings 1087and 1088 couples the motor array 1090 to the support blocks 1076 and1082, respectively. The motor array 1090 is also coupled to a controller1092 that directs a plurality of motors in the motor array. An inputdevice 1096 provides an interface to the system for use by a surgeon.

The mechanical cablings 1087 and 1088 transmit the mechanical movementsof the various motors in the motor array 1090 to the respective supportblocks 1076 and 1082 to provide the linear and rotational movements ofthe catheter 1070 and guide wire 1072. Thus, in the motor array 1090,there may be at least one motor for the linear translation and aseparate motor for the rotational translation for the block 1076.Similarly, there can be motors in the motor array 1090 for both thelinear and rotational translations of the support block 1082.

The controller 1092, maybe a microprocessor that receives input commandsfrom the input device 1096. The input device 1096 may include varioustypes of controls such as a dial, joystick, wheel or mouse. A touchscreen may also be employed as the input device 1096 to inputinformation about the desired location of a particular portion of thecatheter. Details of such a tracking system can be found in the U.S.Application entitled “Catheter Tracking System,” U.S. application Ser.No. 10/216,669, mentioned earlier. Such a tracking system enables anoperator, such as a surgeon, through the input device to select aparticular anatomic body site and direct the catheter directly andautomatically to that site.

Although a manifold 1100 is shown with a single port, the manifold mayinclude multiple ports. The manifold 1100 provides a delivery conduit tothe catheter 1080 for the delivery of fluids to a site in the patient'sbody. For example, one of the fluids 1105 employed may be a contrastfluid for purposes of visualization, which is coupled to a feed line1107 by a valve A. There may also be a drug delivery system indicatedgenerally at 1108 coupled to the feed line 1107 by way of a line 1109 toa valve B. Alternatively, the manifold 1100 can be provided with twoseparate ports with a respective valve A and B in each of these ports.

As shown in FIG. 11B, the manifold 1100 includes an end piece 1200sealed to the back end of the manifold 1100 and provided with an opening1202 through which the guide wire 1072 enters into the manifold 1100,and hence the catheter 1070. Positioned within the manifold 1110 andadjacent to the end piece 1200 is a gasket 1204. The guide wire 1072pierces the gasket 1204 such that the gasket forms a seal about theguide wire. Thus, as fluid enters from the feedline 1107 into themanifold 1100, the gasket 1204 prevents the fluid from leaking out theback end of the manifold 1100.

As indicated previously, the input device 1096 may take on a variety ofdifferent forms. If a wheel, dial, or pivoting switch is employed as theinput device 1096, then one of these may be used for controlling the twodegrees-of-freedom of movement of the catheter 1070, while another suchdevice is used to control the two degrees-of-freedom of movement of theguide wire 1072. Thus, the operator has independent control of the driveor support blocks 1076 and 1082 by way of the input device 1096. Thispermits the operator to selectively move the guide wire 1072 and thecatheter 1070 independently of each other. Typically, the operatoradvances the guide wire 1072 a certain distance, and then the catheter1070, such that the guide wire 1072 can be used to access certain twistsor turns in a body lumen such as an artery or vein.

The input device 1096 may also operate means such as buttons, switches,etc. that provide signals through lines 1111 and 1112 to the respectivevalves A and B for controlling the dispensing of liquids from the fluidsources 1105 and 1108. Although shown coupled to the controller 1092,the lines 1111 and 1112 can be coupled directly to the input device 1096in other implementations.

When the system is in operation, the surgeon advances the catheter 1070and guide wire 1072 through the patient's body with the drive system. Toprovide visualization of the end of the catheter, the surgeon caninstruct, with the input device 1096, the valve A to open. That is, thesurgeon interfaces with the system through the input device 1096 togenerate a signal on line 1111 that opens the valve A to dispense acontrast fluid through the manifold 1000 and the catheter 1070 to thetarget site of interest. Similarly, the surgeon may deliver drugs to thetarget site by instructing the valve B to open which would allow drugsfrom the source 1108 to flow through the catheter 1070 into the body.

In the following discussion, greater detail will be provided about thedrive mechanisms (FIGS. 12-16) and various devices (FIGS. 17-19) used tocouple the medical instruments to the drive mechanisms. Although thedrive mechanisms and connectors are described in reference to thecatheter 1070 and guide wire 1072 discussed above, they can be used inany number of combinations with any of the other medical instrumentsdescribed earlier.

The catheter 1070 referred to in these figures is of the type commonlyused in angioplasty. The catheter 1070 includes a first leg 1300 joinedwith a second leg 1302 at a coupler 1304, and a single extended leg 1306that extends from the coupler 1304. Typically, a part or much of theextended leg 1306 is the portion of the catheter 1070 that is insertedinto the patient. The leg 1302 is connected to an end piece 1305 throughwhich the guide wire 1072 is inserted such that the guide wire 1072typically extends from outside the end piece 1305 through the legs 1302and 1306. As are the legs 1302 and 1306, the leg 1300 is hollow to allowthe transmission of a liquid or gas through the leg 1306 to the surgicalsite. Hence, the leg 1300 would function in much the same way as thefeedline 1107 shown in FIG. 11. The leg 1300 is also provided with avalve 1307 that controls the delivery rate of the liquid or gas, andprevents the liquid or gas from escaping once the liquid or gas sourceis disconnected from the leg 1300. Note that a gasket is typicallylocated in the coupler 1304 or the end piece 1305 that forms a seal withthe guide wire 1072 to prevent the liquid or gas from escaping out theopening of the end piece 1305.

Referring now to FIGS. 12 and 12A, the drive or support block describedearlier is identified as drive mechanism 1308 a associated with thecatheter 1070. As can be seen in FIG. 12A, which is a view of the drivemechanism along the length of the leg 1306, the drive mechanism 1308includes a gripping device 1310 in which the catheter 1070 is secured,and a motor 1312. A belt 1314 is wrapped around pulleys 1315 a and 1315b of the motor 1312 and gripping device 1310, respectively. Hence, asthe motor 1312 rotates, this rotary motion is transmitted to thegripping device 1310 through the belt 1314 as indicated by the doublearrow 1316, such that the catheter 1070 rotates accordingly as indicatedby the double arrow 1318 (FIG. 12).

As shown in FIG. 13, a similar type of drive mechanism 1308 b can becoupled to guide wire 1072 to provide it with a rotary motion asindicated by the double arrow 1318 b. In addition, the drive mechanisms1308 a and 1308 b shown in FIG. 13 also provide the catheter 1070 andguide wire 1072 with linear motion as indicated by the double arrows1319 a and 1319 b (referred to generally as direction 1319),respectively. In certain embodiments, as shown in FIG. 14, the drivemechanisms 1308 a and 1308 b are supported on and slide back and forthalong respective rails 1350 and 1352.

To move the drive mechanisms 1308 a and 1308 b (referred to generally asdrive mechanism 1308) linearly in the direction 1319, variousconfigurations can be used as illustrated in FIGS. 15A, 15B, and 15C.Referring in particular to FIG. 15A, there is shown a lead screw drivearrangement 1360 with a threaded connector 1362 attached to the drivemechanism 1308. A lead screw 1364 is threaded through the connector 1362and coupled to a stationary motor 1366. Accordingly, rotary motion ofthe lead screw 1364 induced by the motor 1366 in the direction 1368results in a linear motion of the connector 1362. Since the connector1362 is attached to the drive mechanism 1308, linear motion of theconnector 1362 produces a consequent linear motion of the drivemechanism 1308 in the direction 1319.

Referring now to FIG. 15B, there is shown a rack and pinion drivearrangement 1370 for moving the drive mechanism 1308 in a linear manner.The rack and pinion drive 1370 includes a rack 1372 attached to thedrive mechanism 1308, and a pinion 1374 coupled to a stationary motor1376. The teeth of the pinion 1374 engage with those of the rack 1372such that as the motor 1376 rotates the pinion 1374 in the direction1378, the rack 1372 and hence the drive mechanism 1308 moves linearlyback and forth in the direction 1379.

Turning now to FIG. 15C, there is illustrated yet another configurationfor moving the drive mechanism 1308 linearly. In particular there isshown a belt/pulley drive 1380 that includes a belt, chain or cable 1382wrapped around a pulley 1386 and a motor pulley 1384 coupled to astationary motor. The belt, chain, or cable 1382 is attached in turn tothe drive mechanism 1308 with a connector 1388. Hence, rotary motion ofthe motor pulley 1384 produced by the motor is transformed into a linearmotion of the connector 1388. Thus, as the motor rotates the motorpulley 1384, the drive mechanism 1308 moves back and forth in thedirection 1319.

Greater Detail of the Catheter 1070 and Guide Wire 1072 Arrangement ofFIG. 13 is illustrated in FIG. 16, and that of the drive mechanism 1308is shown in FIGS. 16A and 16B. In particular, the catheter 1070 andguide wire 1072 are shown as a typical “off-the-shelf” apparatus coupledto a base unit 1400. That is, the base unit 1400 is meant to be easilycoupled to and decoupled from any number of medical instruments, such asthe catheter 1070 and guide wire 1072 combination. In otherimplementations, such as some of those described earlier, the medicalinstrument and base unit is considered as a single instrument not to bedecoupled from each other.

Referring now in particular to FIGS. 16A and 16B, in addition to thefeatures illustrated in FIG. 12A, the drive mechanism 1308 includes ahousing 1401 which encloses much of the moving parts of the drivemechanism 1308. As described before, rotary motion of the motor 1312 istransferred by the belt 1314 to the guide wire 1072 or the leg 1306 ofthe catheter 1070 via the pulley 1315 b coupled to the gripping device1310 (FIG. 12A). The pulley 1315 b itself is supported in the housing1401 with a pair of bearings 1402.

Turning now to the discussion of the connector 1310, to facilitatecoupling the catheter 1070 and the guide wire 1072 to their respectivedrive mechanisms 1308, many types of connectors can be used. In someimplementations, a Toohy Borst type of fitting may be optimal. Anothertype of connector 1310 is shown in FIG. 17A, in which the leg 1306 orguide wire 1072 would be placed in an enlarged portion 1500 of a slot1502. A clamping force 1504 would then be provided to secure the leg1306 or guide wire 1072 to the drive mechanism. For example, as shown inFIG. 17B, the clamping force could be provided with a thumb screw 1506threaded into a block 1508 in which the connector 1310 is mounted. Inanother type of arrangement shown in FIG. 17C, a sliding ring 1510 isfitted over the connector 1310 in the direction 1512. The clamping forcecan also be provided by a vise like device that functions similar to acollet/pin vise.

In another embodiment, as shown in FIG. 18A, the connector 1310 and thepulley 1315 b are one and the same device. Here, the leg 1306 or guidewire 1072 snaps into an enlarged portion 1520 of a slot provided in anextended segment 1522 of the connector device 1310. Since, the enlargedportion 1520 is slightly smaller than the diameter of the leg 1306 orthe guide wire 1072, the legs 1524 of the segment 1522 provide asufficient clamping force to the leg 1307 or guide wire 1072. In thisarrangement, the belt 1314 is wrapped around the pulley 1315 a of themotor 1312 and attaches to the two curved segments 1526 of the connector1310. Thus, rotary motion of the pulley 1315 a produces a rotary motionof the connector 1310, and hence the leg 1306 or guide wire 1072,indicated by the double arrow 1318.

Referring now to FIGS. 19, 19A and 19B, there is shown anotherembodiment of the connector 1310. In this embodiment, the connector 1310includes an inner 1550 and an outer 1552 C-shaped rings. To grasp theleg 1306 or guide wire 1072, the outer ring 1552 is slid over the innerring 1550 in the direction 1554. The guide wire 1072 or the leg 1306 ofthe catheter 1070 is placed in the inner ring 1550, and the outer ring1552 is then rotated or twisted in the direction 1556 around the innerring 1550, thereby capturing the leg 1306 or guide wire 1072.Alternatively, the leg 1306 or guide wire 1072 can first be placed inthe inner 1550 and outer 1554 rings, and then the outer ring 1554 can berotated about the leg or catheter and subsequently slid over the innerring 1550.

Yet another embodiment of the connector 1310 is shown in FIGS. 20A and20B. In this embodiment, the connector 1310 includes a pin vise 1600provided with slot 1602 cut along its length, and a sleeve 1604 that isthreaded onto the pin vise 1600. The pin vise is operated by turning thesleeve 1604 so that as it threads onto the vise 1600 in the direction1606 which causes the slot 1602 to narrow. Thus to secure the leg 1306or guide wire 1072 to the drive mechanism 1308, the leg or guide wire isfirst placed into the slot 1602 as shown in FIG. 20B. The operator thenrotates the sleeve 1604 to thread it over the pin vise 1600, and henceto close the slot 1602 about the leg or guide wire until the pin vise issufficiently tightened about the leg 1306 or guide wire 1072.

This invention can be implemented and combined with other applications,systems, and apparatuses, for example, those discussed in greater detailin U.S. Provisional Application No. 60/332,287, filed Nov. 21, 2001, theentire contents of which are incorporated herein by reference, as wellas those discussed in greater detail in each of the following documents,all of which are incorporated herein by reference in theft entirety:

U.S. application Ser. No. 09/783,637 filed Feb. 14, 2001, which is acontinuation of PCT application Serial No. PCT/US00/12553 filed May 9,2000, which claims the benefit of U.S. Provisional Application No.60/133,407 filed May 10, 1999; U.S. Application entitled “ArticulatedApparatus for Telemanipulator System,” by Brock and Lee, U.S.application Ser. No. 10/208,807, filed Jul. 29, 2002, which is acontinuation of U.S. application Ser. No. 09/827,503 filed Apr. 6, 2001,now U.S. Pat. No. 6,432,112 issued Aug. 13, 2002, which is acontinuation of U.S. application Ser. No. 09/746,853 filed Dec. 21,2000, now U.S. Pat. No. 6,692,485 issued Feb. 17, 2004, which is adivisional of U.S. application Ser. No. 09/375,666 filed Aug. 17, 1999,now U.S. Pat. No. 6,197,017 issued on Mar. 6, 2001, which is acontinuation of U.S. application Ser. No. 09/028,550 filed Feb. 24,1998, now abandoned; PCT application Serial No. PCT/US01/11376 filedApr. 6, 2001, which claims priority to U.S. application Ser. No.09/746,853 filed Dec. 21, 2000, and U.S. application Ser. No. 09/827,503filed Apr. 6, 2001; U.S. application Ser. Nos. 10/014,143, 10/012,845,10/008,964, 10/013,046, 10/011,450, 10/008,457, and 10/008,871, allfiled Nov. 16, 2001 and all of which claim benefit to U.S. ProvisionalApplication No. 60/279,087 filed Mar. 27, 2001; U.S. application Ser.No. 10/077,233 filed Feb. 15, 2002, which claims the benefit of U.S.Provisional Application No. 60/269,203 filed Feb. 15, 2001; U.S.application Ser. No. 10/097,923 filed Mar. 15, 2002, which claims thebenefit of U.S. Provisional Application No. 60/276,151 filed Mar. 15,2001; U.S. application Ser. No. 10/034,871 filed Dec. 21, 2001, whichclaims the benefit of U.S. Provisional Application No. 60/257,816 filedDec. 21, 2000; U.S. application Ser. No. 09/827,643 filed Apr. 6, 2001,which claims the benefit of U.S. Provisional Application No. 60/257,869filed Dec. 21, 2000, and U.S. Provisional Application No. 60/195,264filed Apr. 7, 2000.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

For example, although a detector for sensing relative movement betweenadjacent catheters has been described, a detector for sensing movementof any one or more of the catheters relative to a base position that mayor may not be a location on a particular one of the catheters can beemployed. Also described herein is the use of cabling through thecatheters for controlling the movement of the catheters. In certainembodiments a piezo-electric arrangement may be employed in whichelectrical signal wires would extend through the catheter system foractuation of a mechanical (piezoelectric) member to provide motion ofthe distal end of the catheter.

1. A method of performing a medical procedure using a coaxial catheterarrangement including an outer catheter having a proximal balloon, andan inner catheter having a distal balloon, the method comprising thesteps of: a) introducing the coaxial catheter arrangement within ananatomical vessel of a patient; b) inflating the proximal balloon toanchor the outer catheter within the anatomical vessel; c) afterinflating the proximal balloon, linearly translating the inner catheterrelative to the outer catheter within the anatomical vessel in thedistal direction; d) after linearly translating the inner catheterrelative to the outer catheter, inflating the distal balloon to anchorthe inner catheter within the anatomical vessel; e) after inflating thedistal balloon, deflating the proximal balloon to release the outercatheter from the anatomical vessel; f) after deflating the proximalballoon, linearly translating the outer catheter relative to the innercatheter within the anatomical vessel in the distal direction; and g)after linearly translating the outer catheter relative to the innercatheter, deflating the distal balloon to release the inner catheterfrom the anatomical vessel, wherein the steps b) to g) are performedautomatically.
 2. The method of claim 1, further comprising repeatingthe foregoing steps to cause incremental movement of the coaxialcatheter arrangement within the anatomical vessel.
 3. The method ofclaim 1, wherein an electric controller is used to direct anelectromechanical driver to linearly translate the outer and innercatheters relative to each other and a balloon controller for inflatingand deflating the proximal and distal balloons.
 4. The method of claim1, further comprising conveying at least one command to the electriccontroller via a user interface.
 5. The method of claim 1, furthercomprising actuating an articulating tool on the inner catheter withinthe anatomical vessel.
 6. The method of claim 1, wherein the anatomicalvessel is a blood vessel.